Feature

Dangerous, disorderly and deviant — or just disabled?

Policy towards people with a learning disability has been marked by deep ambivalence. David Barker looks back on the ‘colonies’ for the ‘mentally defective’

It is a safe bet that Sir Geoffrey Howe will be remembered mainly as Margaret Thatcher’s first Chancellor and then as the epicentre of the shock that hit British politics at the end of 1990. But he has another claim to fame: in 1969 he chaired the Committee of Inquiry at Ely, a mental handicap hospital near Cardiff, after a nurse alleged ill treatment, malpractice and unacceptably low standards of patient care.

The reverberations of the Ely inquiry were extensive. It influenced social behaviour, with more whistleblowing, inquiries and anti-scandal strategies and affected public policy with the white paper Better services for the mentally handicapped accelerating deinstitutionalisation. And it had a direct influence on academic research.^{1 2 3}

This work has warned of the effects of geographical, social and professional isolation, the impact of bureaucracy and different kinds of training on patterns and standards of care, the limitations of lay management in a professionally dominated service and the insidious process leading to ‘corruption of care’. Common to most of these explanations of the crisis in mental handicap hospitals is the assumption that good intentions and noble ends became distorted. The problem has been to explain the distortions.

The establishment and expansion of these institutions or ‘colonies’ for the ‘mentally defective’ took place predominantly during the Edwardian and inter-war period. Official documents provide a picture of their formal goals and operating principles.

A constant theme of these reports is a marked ambivalence about the nature of the inmates. Thus ‘defectives’ (usually ‘lower’ grades) were seen as helpless, vulnerable, dependent and often neglected. What they needed therefore was institutional care and protection. But equally the mentally deficient were regarded as deviant, dangerous, disorderly, immoral and unproductive; indeed such patients, usually ‘higher’ grades, tended to be admitted when they had ‘run the whole gamut of their indiscretions in the outside world’. What they needed was institutional control, stabilisation and discipline.

This ambiguous view of the inmates is reproduced in statements about the operation of the institution. Some emphasised ways in which the institution secured the welfare and happiness of its patients who were ‘easy, kindly people to manage, just like so many children with rather short memories’. Others tell a different story.

First, the institution set out to transform the unproductive and economically burdensome into stable, useful workers. Its goal was economic self sufficiency, with patients labouring to produce the goods and services necessary for subsistence. This economic role had far-reaching implications for a colony’s size, location, design and staffing; for resource allocation; for the socialisation of the colony’s children; for the division of labour between men and women.

The economic imperatives also meant a highly stratified labour force: ‘the high grade patients and the skilled workmen of the colony, those who do all the higher processes of manufacture [and hold] a considerable measure of responsibility; the medium grade patients are the labourers who do the simple routine work in the training shops and about the institution; the best of the lower grade patients fetch and carry and do very simple work like cleaning spoons or polishing the floors, and quite the lowest grade are the drones for whom all the others work’.

An epidemiological survey in 1929 estimated that the ‘deadweight’ which the institution would have to ‘carry’ might comprise nearly a fifth of patients. The tension between the institution’s role as caregiver and manufacturer both of cheap goods and services, and of productive workers, is very apparent.

Second, the colony was to regulate sexual behaviour (and other misbehaviours). There is much more to this than the true but trite observation that the sexes were rigorously segregated. The colony was intended to be part of a systematic operation to police behaviour in the community, where a major concern was to ensure that ‘defectives’ should not ‘form friendships with members of the opposite sex’. The power to arrange ‘some closer form of control’ was the ultimate weapon in the armoury of ‘lady visitors’, supervisory officers, hostel matrons and others responsible for statutory supervision.

For many ‘defectives’, life on the outside was akin to lifelong probation, since the fact that he or she ‘is on license and can be recalled at any moment acts as a valuable deterrent and goes far to ensure good behaviour’. Again there are severe strains in evidence, with declarations that institutions were happy places where inmates were unaware of restrictions on their liberty.

’Defectives’ were seen as transmitters of venereal disease, as immoral and lacking in sexual control, as bad parents and as disproportionate contributors to racial decay. Here we should note that these reports are replete with eugenic discourse about degenerate stock and so on. This sits awkwardly with statements about the promotion of happiness and welfare.

Finally there is a stark contradiction on the crucial questions of discipline and security. To take just one example, withdrawal of pocket money is presented as the ‘loss of a small privilege’. But it also meant no pay for work done, and we know from David Barron’s autobiography that in one institution this withdrawal was accomplished through a degrading public ritual and could have appalling medical consequences for addicted smokers who were reduced to fashioning cigarettes out of dust and newspaper.⁴ In short, harsh measures were required to create remoralised, stabilised and productive inmates.

The crisis investigated by Sir Geoffrey was largely the product of cultural continuities and material discontinuities with this past. Deeply ingrained beliefs about mentally handicapped people and appropriate ways of treating them survived the somewhat half-hearted attempts at reform during the first two decades of the NHS. But the hospitals as economic units were transformed. Full employment and the efforts of civil liberties organisations steadily drained away their more able and productive worker-patients and nurses were left to cope with more dependent and difficult patients, with diminishing human resources to assist them.